The predictive value of G8 and the Cancer and aging research group chemotherapy toxicity tool in treatment-related toxicity in older Chinese patients with cancer

Chan, Wing‐Lok; Ma, Tiffany; Cheung, Kwok-Leung; Choi, H.C.W.; Wong, Josiah Hiu-yuen; Lam, Ka-On; Yuen, Kwok-Keung; Luk, Mai‐Yee; Kwong, Dora L.W.

doi:10.1016/j.jgo.2020.10.013

Cited by 18 publications

(14 citation statements)

References 37 publications

(10 reference statements)

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“… 10-16 Most of the patients were younger than in the ELCAPA cohort, and the median age was below 75. 10-13 , 15 Two of the studies looked at a single type of cancer only (lung cancer and prostate cancer, respectively), 11 , 14 and only 3 studies included more than 200 patients. 10 , 15 , 16 When considering the 4 studies in which predictive performance was estimated, 2 reported an AUC above 0.7 (0.72 and 0.78, respectively), 10 , 12 and 2 reported an AUC below 0.6 (0.52 and 0.54, respectively).…”

Section: Discussionmentioning

confidence: 99%

“… 10-13 , 15 Two of the studies looked at a single type of cancer only (lung cancer and prostate cancer, respectively), 11 , 14 and only 3 studies included more than 200 patients. 10 , 15 , 16 When considering the 4 studies in which predictive performance was estimated, 2 reported an AUC above 0.7 (0.72 and 0.78, respectively), 10 , 12 and 2 reported an AUC below 0.6 (0.52 and 0.54, respectively). 15 , 16 Only 2 studies (with respectively 120 and 106 patients) evaluated both the CARG and CRASH scores: the AUCs were 0.68 and 0.77 for the CARG score, and 0.65 and 0.77 for the CRASH score.…”

Section: Discussionmentioning

confidence: 99%

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External Validity of Two Scores for Predicting the Risk of Chemotherapy Toxicity Among Older Patients With Solid Tumors: Results From the ELCAPA Prospective Cohort

et al. 2023

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Background Severe chemotherapy-related toxicities are frequent among older patients. The Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) and the Cancer and Aging Research Group Study (CARG) score were both developed to predict these events. Patients and Methods The objective of this study was to evaluate the scores’ predictive performance in a prospective cohort, which included patients aged 70 years and older referred for a geriatric assessment prior to chemotherapy for a solid tumor. The main endpoints were grades 3/4/5 toxicities for the CARG score and grades 4/5 hematologic toxicities and grades 3/4/5 non-hematologic toxicities for the CRASH score. Results A total of 248 patients were included, of which 150 (61%) and 126 (51%) experienced at least one severe adverse event as defined respectively in CARG and CRASH studies. The incidence of adverse events was not significantly greater in the intermediate and high-risk CARG groups than in the low-risk group (odds ratio (OR) [95% CI] = 0.3 [0.1-1.4] (P = .1) and 0.4 [0.1-1.7], respectively). The area under curve (AUC) was 0.55. Similarly, the incidence of severe toxicities was no greater in the intermediate-low, intermediate-high, and high-risk CRASH groups than in the low-risk CRASH group (OR [95%CI] = 1 [0.3-3.6], 1 [0.3-3.4], and 1.5 [0.3-8.1], respectively). The AUC was 0.52. The type of cancer, performance status, comorbidities, body mass index, and MAX2 index were independently associated with grades 3/4/5 toxicities. Conclusion In an external cohort of older patients referred for a pretherapeutic GA, the CARG and CRASH scores were poor predictors of the risk of chemotherapy severe toxicities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

External Validity of Two Scores for Predicting the Risk of Chemotherapy Toxicity Among Older Patients With Solid Tumors: Results From the ELCAPA Prospective Cohort

et al. 2023

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“…Other studies have evaluated the utility of the CARG model outside the US. [44][45][46] Within the continent of Asia, Ostwal et al 44 have validated the utility of the CARG model in the Indian population. Suto et al 45 have similarly found that the CARG model predicted chemotherapy-related toxic effects in a small (<100 patients) retrospective study conducted in a Japanese population, whereas a prospective validation study 46 of the CARG performed in Hong Kong had negative results, which may be attributed to the inclusion of patients who received only targeted therapy and no chemotherapy in the study population.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies have evaluated the utility of the CARG model outside the US . Within the continent of Asia, Ostwal et al have validated the utility of the CARG model in the Indian population.…”

Section: Discussionmentioning

confidence: 99%

Use of the Cancer and Aging Research Group Predictive Model for Chemotherapy-Related Toxic Effects in a Multiethnic, Older Adult Asian Population

Pang

Low

et al. 2022

JAMA Netw Open

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ImportanceThe Cancer and Aging Research Group (CARG) prediction model for chemotherapy-related toxic effects has been developed but not yet validated in older Asian adults. In view of differences in drug metabolism and toxic effect reporting in the Asian population, the ability of this tool to guide the cancer treatment decision-making process in older Asian adults needs to be assessed.ObjectiveTo examine the validity of the CARG predictive model in a multiethnic Asian cohort of older adults.Design, Setting, and ParticipantsIn this prognostic study, patients of various Asian ethnicities 70 years or older with a solid tumor diagnosis receiving chemotherapy at the National University Cancer Institute, Singapore, were accrued from June 1, 2017, to January 1, 2019. Their risks of chemotherapy-related toxic effects were calculated using the CARG tool. A geriatric assessment was performed, and the treating oncologist (blinded to the CARG scores) was asked to give an estimated likelihood of toxic effects (low, medium, or high). Chemotherapy-related toxic effects were recorded during each clinic visit. Validation of the prediction model was performed by calculating the area under the receiver operating characteristic curve. Multivariate analyses were performed to identify variables in other domains in the geriatric assessment predicting for severe toxic effects.Main Outcomes and MeasuresGrade 3 to 5 toxic effects and hospitalization.ResultsThe study included 200 patients (median age, 74 years [range, 70-89 years]; 110 [55.0%] male; 177 [88.5%] Chinese, 17 [8.5%] Malay, 4 [2.0%] Indian, and 2 [1.0%] other ethnicities [according to Singapore’s national system of race classification]). A total of 137 patients (68.5%) experienced grade 3 to 5 toxic effects, and 131 (65.5%) required hospitalization. The area under the receiver operating characteristic curve for the CARG chemotoxicity prediction model was 0.74 (95% CI, 0.67-0.82), retaining good discrimination in the study population.Conclusions and RelevanceThis prognostic study conducted in a multiethnic Asian cohort of older adults supports the validity of the CARG predictive model in this population, predicting which older adults are at risk of chemotherapy-related toxic effects.

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“…This may affect the validity of geriatric screening tools and chemotherapy prediction tools in these settings. In a study of older Chinese patients with cancer, for example, the G8 and the CARG chemotherapy toxicity tool demonstrated weak prediction of severe treatment-related toxicities [40]. Future studies should seek to incorporate more diverse populations of older patients and current findings supporting GA-directed care need to be tested in TLMLICs and non-Western countries prior to being broadly implemented.…”

Section: Application Of Geriatric Assessment-directed Care To Other C...mentioning

confidence: 99%

Geriatric assessment-informed treatment decision making and downstream outcomes: what are the research priorities?

Hsu

Leung

Mariano

2021

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of reviewGeriatric assessment (GA) can predict outcomes relevant to patients and clinicians but is not widely used. The objective of this review is to summarize the evidence supporting use of GA to facilitate decision making and improve outcomes and identify gaps that need to be addressed to further bolster the rationale for the use of GA. Recent findingsRecently several randomized controlled studies exploring the impact of GA-directed care have been reported. Although GA-directed care has not been shown to improve survival, it can decrease moderate to severe toxicity from chemotherapy, increase the likelihood of completing planned chemotherapy and improve quality of life without adversely affecting survival. In the surgical setting, GA-directed care may decrease duration of hospitalization, but does not affect rates of re-hospitalization. SummaryGA-directed care can improve patient-important outcomes compared to usual care. However, more research on whether these findings apply to other contexts and whether GA-directed care can improve other outcomes important to patients, such as function and cognition, is needed. Also more clarity about how oncologic treatments should be modified based on results of a GA are needed if oncologists are to utilize this information effectively to obtain the reported results.

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The predictive value of G8 and the Cancer and aging research group chemotherapy toxicity tool in treatment-related toxicity in older Chinese patients with cancer

Cited by 18 publications

References 37 publications

External Validity of Two Scores for Predicting the Risk of Chemotherapy Toxicity Among Older Patients With Solid Tumors: Results From the ELCAPA Prospective Cohort

External Validity of Two Scores for Predicting the Risk of Chemotherapy Toxicity Among Older Patients With Solid Tumors: Results From the ELCAPA Prospective Cohort

Use of the Cancer and Aging Research Group Predictive Model for Chemotherapy-Related Toxic Effects in a Multiethnic, Older Adult Asian Population

Geriatric assessment-informed treatment decision making and downstream outcomes: what are the research priorities?

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